Slashdot videos: Now with more Slashdot!

View

Discuss

Share

We've improved Slashdot's video section; now you can view our video interviews, product close-ups and site visits with all the usual Slashdot options to comment, share, etc. No more walled garden! It's a work in progress -- we hope you'll check it out (Learn more about the recent updates).

dcblogs writes that the Obama Administration is urging tech entrepreneurs "to sign up for health insurance under the Affordable Care Act, and said having the coverage will give them the 'freedom and security' to start their own businesses. 'There is strong evidence that when affordable healthcare isn't exclusively tied to employment, in more instances people choose to start their own companies,' wrote White House CTO Todd Park in a post to launch its #GeeksGetCovered campaign. Bruce Bachenheimer, a professor of management at Pace University and director of its Entrepreneurship Lab, said the effort is part of a broader appeal by the White House to get younger and healthier people to sign-up for Obamacare, and is in the same vein as President Obama's recent appearance on Between Two Ferns." Removing the tax structures that make companies by default intermediaries in the provision of health insurance, and allowing more interstate (and international) competition in health finance options would help on that front, too, aside from who's actually footing the insurance bill.

I was on my own with a full-time consultancy, but I scaled it back to off-hours and went back to a forty-hour-a-week corporate job for the health insurance. The cost of individual health care plans was insane, and the crappy ACA plans provide worse coverage with fewer providers - and they're even more expensive!

I really think what the feds are up to here is trying to kill off as many individual and small business operators as possible. After all, it's a lot easier to monitor and tax large corporate entiti

I found a few years ago...while doing 1099 through my S corp, that it wasn't that bad for insurance.

I had (at the time) a high deductible plan, basically what used to be called "major medical", for needs if I got hit by a bus, etc.. The deductible was only about $1200.

I coupled that with a HSA (Health Savings Account) which unlike the FSA's are not use it or lose it, they roll over annually. I socked away about $3K pre-tax annually and out of that, I paid my routine med visits and drugs.

Minimums are needed because cross subsidisation is rather integral to having affordable healthcare for everyone. Meaning those who are in the stage of their life that don't need much medical care pay more, but those that do are able to afford it.

I definitely agree with the suggestion that you need to break the link between healthcare and employment. Because there's obviously a very strong link between unemployment and needing medical care. I love living in a country with universal healthcare funded by taxation. Sure it means that I end up paying a lot more than I otherwise would, but it provides a safety net for everyone - including me should I happen to get unlucky and end up sick and unemployed. People don't end up having to declare bankruptcy because of medical bills or go without life saving medical care. And everyone is able to access a reasonable standard of healthcare (and the wealthier are not restricted from getting gold plated service if they wish to pay for it). But hey I realise that for a lot of Americans that concept is just communism so it'll never happen

"Minimums are needed because cross subsidisation is rather integral to having affordable healthcare for everyone."

Yes. Cross-subsidization (also known as "socialism") has resulted in most people I have spoken to paying 40% to 60% more on their premiums, with a higher deductible.

It has also resulted in fewer young people with insurance, because their premiums went way up. It's DUMB to raise rates on the demographic that (A) is essential to funding the program, and (B) needs it the least.

I grant that it is a good thing to get insurance away from ties to "traditional" employment. But doing so through Obamacare is kind of like cleaning your windows by taking a sledgehammer to them.

Whoa. Hold on there. I am not of the generation you are blaming but you need to step back and get a little perspective. At least I think I'm not... because "your generation" is rather ambiguous. I am probably older than you, but a lot of these things were actually done by a full generation before me. (If you define "generation", as the time it takes for someone to grow up and have children, which these days averages almost 30 years.)

Yes, the early boomers did rape Social Security "for their own benefit",

The deductible you're talking about in your old plan would pay nothing until you reached the deductible.

The deductible in an ACA plan does not apply to a large number of routine procedures. Those are covered with a co-pay instead. For example, instead of paying full price for a check-up because you haven't hit the deductible, you pay around $10-40 depending on plan.

The deductible in an ACA plan does not apply to a large number of routine procedures. Those are covered with a co-pay instead. For example, instead of paying full price for a check-up because you haven't hit the deductible, you pay around $10-40 depending on plan.

This does not seem to be the case for any of the plans I looked at. And even when I hit deductible, the insurance on most of these plans seem to only pay about 70% tops of the bills.

The government doesn't set prices for procedures. The fed could extend the medicare pricing list to everyone instead of having to deal with each insurance company's "negotiated pricing" and arcane "most favored nation" contract rules. Or maybe employers could be required to offer up the cash that would have been spent on the company health plan so you can shop for yourself. Shopping for insurance across state lines would certainly be nice! Also, repealing state regulations that limit the size/capacity of hospitals.

My HSA should stay that way, if it's my money, no one should be able to take it but me!...Actually, I wish my HSA could be grown and used as some kind of bond-like health insurance that also lowers my own premiums over time.

There are lots of political problems that could be fixed without repealing the ACA. 99% of it is removing greed, the #1 killer in America.

I'm looking to go that route again, but man...I looked at the health sherpa site that shows what obamacare offers in my area, and deductibles on anything but near gold plans is over $3K?!?!?

I got a technically silver PPO plan (effectively gold if I stay in network with Blue Cross) that is compatible with an HSA. (HSAs are great) Cost to me is about $300/month and I get no subsidy. $4800 out of pocket max and $3K deductible. Everyone worries about the deductible but that isn't the important bit. The important bit is the out of pocket max. Health insurance isn't supposed to be to pay for your regular checkup. It's to keep you from going bankrupt if something serious happens.

I would end up on many plans paying about $3K a year in premiums AND $3K+ in deductibles before I started having any insurance kick in. WFT?

$6K/year is about right for real health insurance. What you had previously was "junk insurance" - them paying for and covering the bare minimum. If you were diagnosed with leukemia, your HSA would have been wiped out in the first week and your insurance company would have dropped you as soon as it could legally get away with it. A course of leukemia is going to set them back a cool million bucks, so they'd do ANYTHING they could to retroactively decide you lied on your insurance application and they didn't have to do anything.

Not true, I know how to read for myself my policies. I had the same good coverage for an emergency that I have now on a W2 gig. The chief difference was that I just paid my own way for routine Dr. visits and meds.

Insurance is supposed to be there for EMERGENCIES, not to run you $10 copay for routine Dr. visits. That needs to be something you save and pay for, just like any other necessity of modern life, like utilities, food and gas.

This is the type of policy and situation that is usually perfect for healthy younger folks that don't need tons of coverage for routine things.

Depending on where you go, a "routine" doctor's visit can range from $50 to $200. Still, it's much cheaper for both you and an insurance company to cover a once a year "wellness" visit and catch anything early on than it is for you to skip the yearly visit since it costs an extra $50, and then suddenly learn you've had a slow growing tumor in your ear and now you're goin

The Harvard study they relied on? It's crap [theatlantic.com]. Note that even your link only claimed 57%. I would dispute whether that qualifies as a VAST majority.

The self reported figure from the study came in at 29%, which is probably a better number. The 62%, and even the 57% in your link rely on a very broad definition of medical bankruptcy. Some with $500,000 in other debt and $5,001 in medical debt [heritage.org] shouldn't really count as a medical bankruptcy.

Depending on where you go, a "routine" doctor's visit can range from $50 to $200. Still, it's much cheaper for both you and an insurance company to cover a once a year "wellness" visit and catch anything early on than it is for you to skip the yearly visit since it costs an extra $50, and then suddenly learn you've had a slow growing tumor in your ear and now you're going deaf.

Your main point is right. Co-payments are terrible health policy.

Actually, the most common example is people with asthma. If they use their controller medication, they won't get asthma attacks, but the controller medication can be expensive. There were health insurance plans that covered 100% of medication costs. Then they shifted to co-payments. Even with small co-payments, people stopped taking their controller medication. They got asthma attacks, and wound up in the hospital. One ER trip will cost as much as several years of controller medication. So the plans wound up paying more under co-payments as they did with 100% payments. Same with co-payments for blood pressure medication -- more heart attacks and strokes. If you want to look this up, to make sure I'm not repeating an urban myth, it was reported in the New England Journal of Medicine by Amal N. Trivedi, who published a few other studies like that. Also see the Rand Health Insurance Experiment on Wikipedia or elsewhere.

Insurance is supposed to be there for EMERGENCIES, not to run you $10 copay for routine Dr. visits. That needs to be something you save and pay for, just like any other necessity of modern life, like utilities, food and gas.

That's one of those ideas that sounds good but doesn't work when you try them out in the real world. Most other developed countries have health care systems that pay 100% of costs (although non-American Slashdotters may be informative on that). Health insurance isn't car insurance.

The biggest problem is that once people have to pay for "routine" visits, they don't go on routine visits. Obviously you are one of those people who can afford to pay for a $200 doctor's visit out of pocket. Maybe half of American

Our good pal Brandon "Offworld" Boyer has cancer. Lucky for Brandon, he signed up for medical insurance with Humana not long before he was diagnosed. Unlucky for him, Humana has decided unilaterally not to cover his cancer treatments and has stuck him with with a $100,000 bill.

Ok, they suffer the consequences of their actions.Those consequences result in them having major operations that could have been prevented.End of story right? Nope, they just racked up a bill that you're helping to pay off through insurance.. and to what tune? To the tune of the next 10 years of their regular check-ups and maintenance in 1 go.

So which do you want? Higher premiums or regular maintenance?

Ounce of prevention, pound of cure. It's not just a saying. You're going to be paying for my pound of cure

I'm skeptical of any anecdotes I hear about obamacare. On top of the fact that anecdotes aren't real evidence, there have been several well-publicized obamacare horror stories that have turned out to be far-right funded lies.

The other way is also true. The "strong evidence" that obamacare is going to make many more startups doesn't seem to be much more than a theory. Here's the study they're referring to. [rwjf.org] Seems odd that they don't show self-employment increasing in Massachusetts, given that Romneyca

The cost of individual health care plans was insane, and the crappy ACA plans provide worse coverage with fewer providers - and they're even more expensive!

I have exactly the opposite experience. I got a better plan for roughly the same cost and I had numerous to choose from. I also was able to get a Health Savings Account which is a great deal if you are eligible for one. My out of pocket maximum is around $4800 per year which I can easily manage if I have to. Most importantly my ability to get and keep health insurance is no longer tied to a specific employer which is LONG overdue. It should never be the case that losing your job should cause you to lose your health insurance. That's just morally wrong.

I really think what the feds are up to here is trying to kill off as many individual and small business operators as possible.

I run a small business (a manufacturing company) and the Affordable Care Act has been hugely helpful to us. Our employees were able to get similar coverage to what they had with our company plan, usually for less money out of pocket. Plus the company did not have to pick up any of the cost which saves our company roughly $10,000 per year. Basically we were paying roughly $550 per employee per month and the company picked up half the cost for an HMO. Now our employees are paying between $130-250/month out of pocket and the company doesn't have any of the cost.

Any of those savings (which could be considered part of an employees salary) get passed on to the employee?

Any of those savings (which could be considered part of an employees salary) get passed on to the employee?

We were able to give raises we couldn't before. The company kept some of the savings and some of it got passed on.

The challenge is that we offered health coverage to everyone but not everyone took it. That was their choice to forego the insurance. It's unfair (and can create legal problems) to give raises only to those who took insurance through our company when others are doing the same job just as well. Any time you have two people doing the same job you have to have a justification if you are going to pay them differently based on responsibilities or performance. We also offer an IRA with an employer match but not everyone chooses to participate. We don't give raises to those who don't participate.

Here's what Krugman had to say. If you say you did the math, you might be right, but there are a lot of BS health care stories out there. The big benefit of Obamacare is that it limits your (pemium+copayments) to ~$8,000. One big weakness of Obamacare is that when you find an "affordable" plan, it might have a small pool of doctors, it might not have a doctor that you've been using, and it might not have an competent doctors at all. Single payer would have been better, but, as Uwe Reinhardt says, the American political system is too corrupt for that.

http://www.nytimes.com/2014/02... [nytimes.com]Health Care Horror HooeyPaul KrugmanFEB. 23, 2014(Right-wingers convinced Americans that farms are being broken up to pay "death tax" estate liabilities, but there is not one single example. Now the Republicans are creating Obamacare horror stories, which don't hold up upon fact checking. In the GOP response to the State of the Union address, Rep. Cathy McMorris Rodgers claimed "Bette in Spokane" had lost her good insurance and was forced to pay $700 a month more. Local reporters found the real Betty, and found out [Bette Grenier had a catastrophic plan, and she refused to look on the ACA web site.] In Michigan, Americans for Prosperity, funded by the Koch Brothers, is running an ad about Julie Boonstra, who has leukemia, saying that her new policy will have unaffordable out-of-pocket costs. But Glenn Kessler of the Washington Post found that she will be saving more than she will be paying in out-of-pocket costs. [The Obamacare out-of-pocket maximum is $6,350. Her premiums were cut in half, from $1,100/mo to $571/mo.])[T]he true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.

For a family with two 40 year-old non-smokers and two children under 21, making the median household income of $50,054/year, the average annual silver plan premium, nation-wide would be $9700/year. That's a lot, but not unreasonable given what a silver plan covers. But here's the kicker: Uncle Sam cuts your taxes to the tune 65% of your premium, so effectively you only pay $3373/year. If you were getting anything close to silver plan coverage for much less than $281/month, I'd b

Now there's the BS - you sound like the people who encourage everyone else to ride public transportation (without riding it themselves) right now.

Trust me - I did the math. ACA's benefits, including access to providers, were well below what I was getting with my expensive individual insurance policy a few years ago. With a couple of kids doing sports and the occasional illness, the difference between paying out of pocket for my own health insurance vs. snuggling back up to a megacorp (and dodging the self-employment tax) made it a no-brainer.

Before we continue, please tell me that you already signed up and paid for your ACA policy, and love what it does for you.

were well below what I was getting with my expensive individual insurance policy a few years ago.

Of course medical costs were much cheaper a few years ago. Why do you think the ACA finally got enough traction? Insurance costs are outpacing inflation at incredible rates.

It is worth remembering that insurance companies must comply with regulations requiring them to pay out a percentage of their revenue and ACA gives them more revenue in the form of previously uninsured people being forced to become customers. If your insurance went up during the last few years, it was not the ACA it was either pricier ri

Traction? Democrats have been wanting to take over healthcare for years. They finally got their chance and they ramrodded it through. There was no traction.

Ramrodded through the 1990s Republican plan, in fact. Because the 2010 Republicans would rather die than work with Democrats, even if it means repudiating their own ideas.

The old health care paradigm was broken. It was based on the idea that the majority of people went to work for a single employer and stayed there for life, so that they didn't have to deal with the "pre-existing condition" gotcha. It assumed that employment was more or less continuous, instead of months, and even years between jobs when so

With "take over" you actually mean "do anything about". The Republicans had, and still have, absolutely no ideas whatsoever about how to fix our broken healthcare system (well, they did have one idea a few years back that involved keeping a system of mainly private health insurers and stipulating a mandate that people need to sign up. But they seem to have abandoned that as of late..........)

It varies from state to state! Stop saying "The ACA raise health care costs!" then "no it didn't!" "yes it did!" "no it didn't!"

If the ACA laws match what your state already had, then the plans will remain the same and the costs will remain the same. If the ACA requirements were higher/stricter than what your state required, then your insurance benefits and costs will increase. If the ACA requirements are lower than what your state required, then... I'm not sure...

I live in Maryland, where most but not all of the ACA rules were already in place. My individual health insurance plan will change very little. It was +/-10% from what my employer offered. The ACA now requires a few provisions that resulted in a nominal increase in my health care costs.

My local NPR station, WYPR, has had a program "Maryland Morning" where they have been going over this for months. They compared to other states where costs are going up because those states allowed health care plans that covered nothing but hangnails and scraped knees.

And if all the coverage you wanted was for hangnails and scraped knees, then why should you be forced to buy coverage for things you don't want, and in many cases will never need?

Because you usually don't pick and choose what injuries and illnesses you get. We've already decided as a society that we're not just going to let people die in the street and that medical personnel have to treat patients. So you're going to get treatment, the ACA ensures that you have actual coverage for it rather than freeloading.

It's still a totally broken system though; no way should health care have ever been tied to employment. For one thing, doing so masked the actual costs of health care and insuran

"I was getting with my expensive individual insurance policy a few years ago."and you left consultancy to go to the corporate world...why? No one took away expensive individual insurance policies.

YOU CAN STILL BY INSURANCE ON THE OPEN MARKET.And you get all the benefits from the insurance reform. So if your child develops a disease* you insurnace company can't jerk you around, and later in life you child won't be denied.

You should look at any increase costs and compare them to pre-Obama insurance rate incre

I am. Cost me 12% more than last year. Which is about how much my plan went up 3 years ago, and about 4% more than it went up last year. I cover myself, wife, and child.

And you must be the shittiest consultant in the world if a 1% penalty (this year) or a 2.5% penalty (cap, in 3 years) on your AGI will cost you more than losing your consultant income. If you get taxed on $100,000 a year, it will cost you $1000 this year; $2500 next year. If you're not making at least 50% more as a consultant as you do as a grunt, you're doing it wrong.

I was with a start-up for a little over a year. One of the conditions I had for joining with them was that they would cover my COBRA expenses, because a) I couldn't afford it with my start-up salary and b) I couldn't get independent coverage because of a few preexisting conditions with me and my family. People forget about that clause. And lord help you if you are pregnant or have a pregnant wife (or want to get pregnant soon). Impossible to get coverage (or so I was told by two different brokers).
Say what you want about Obamacare, but just the change of getting reasonably priced insurance even with preexisting conditions is enough for some people to have the freedom to jump into start-ups. Whether it's "right" or "wrong" is a completely different story.

I'm definitely calling BS on this one. By huge margins, people were happy with their insurance plans pre-Obamacare (statistics bear this out). I was, and many people I know were too.

Now, I am worried what will happen when all the regs finally do kick in. I have a great plan now through work for my family and I, and I know if ObamaCare isn't changed or repealed, my out of pocket costs will absolutely jump by hundreds of dollars. Why? Because our plan now doesn't technically cover all the things that Oba

So we've got young and middle aged people carrying the burden of health care costs for their elders (been that way as long as I've been alive), the least you can do is kick in for contraceptives and maternity care. It's only fair. It's not like fairness and consideration for others is a cornerstone of a functioning society or anything.

Too many people would rather burn it all down if it isn't done their way, or it benefits people they don't value.

Does the threat of violence oppress you from strolling to work nude? Do you pay for groceries under the specter of a gun? Is violence the only thing that keeps you from running your sewage line into a creek that passes through your property?

Thanks for that. I am not in the individual insurance marketplace. I think obamacare is better then the alternative of doing nothing, but I really want a single payer plan. Insurance needs to be divorced from employment. If i have to pay for it anyway, why not make it a tax and do it right.

BTW, I have a pretty well fleshed out account for a sock puppet. I'm pretty sure my real name could be easily linked to this account. Unlike the AC who is calling me out and probably works for some GOP politician, or is

I too could not afford it, it's not a "few hundred bucks!" I have a family of 4 total and it was going to cost me $1800/month with a $5,000 - $10,000 deductible. I don't remember the exact deductible but I recall it being of $5K. It did not pay for doctor visits until I hit the deductible amount. Basically a High Indemnity plan for $1800.00 a month! I had just left a corp. so I signed up for COBRA which gave me a PPO for $1400.00/month and a $800 deductible with $35 doctor visits. But COBRA is temp

I have a family of four, and I am paranoid about coverage so I have a low deductible and lots of coverage.1000 a month. Maybe you need to look around more? is there some state based thing that's getting you?

"$1800/month with a $5,000 - $10,000 "that's.. well stupid. Are you a smoker?

Are you sure you've actually looked at it?Here is what I get for 1000.10 a month and my income gets no subsidies, and I live in Oregon:

A few hundred? Try $800/month which is the cheapest plan the ACA offers where I live. And that plan was total garbage, didn't cover half of what you'd expect and had huge co-pays.

The problem with ACA is that it MANDATED HMO's... Not health insurance. Some people don't need an HMO... if you're running a moderately successful home business you're usually making enough money to cover your families medical expenses out of pocket. What you couldn't afford is catastrophic injuries like car accidents, cancer, heart attacks, etc... So you'd get a very limited policy for that. It wouldn't pay for prescriptions and such but if you started getting $200k hospital bills it would kick in. Those plans were pretty cheap... in the $200/range.

ACA made those kinds of plans illegal. Now you have to buy plans that cover all those things you didn't need... and they cost a fortune. If I tried to get the plan I have with my employer through the ACA exchange it would be over $1600/month. That's insane! And yes, I actually looked it up.

Ironically, one type of small business is flourishing because of all of this. My best friends father is an insurance salesman. When the ACA passed he was terrified... he'd go out of business. He's an older, cranky, eastern European man and hates democrats so that made it even worse. But when the reality finally dawned on him and everyone's insurance policies got canceled, he suddenly LOVES Obama. You see, he makes a commission on insurance sales. Because all of his clients now have to re-sign up for their insurance, he's basically making back all the money he already made off all of his clients the first time he signed them up.

Depends on your age, I'm turning 60, and the wife is 62, health insurance for us is in the neighborhood of $1,200 - $1,900 per month; that's more than most mortgage payments! There no rhyme or reason for the prices that is appearent, there are plans with deceint coverage and high deductables that are cheaper than plans with for-crap coverage and deductables of $20,000! My subsidy is just over $900.00 which is good for me, not so good for the rest of the taxpayers.I know this sounds outlandish, so here's Sub [kff.org]

If hospitals are making such profits on overcharging patients and insurers, why aren't insurers taking an ownership interest in hospitals so that they can see some of these profits?

Uncertain, but perhaps it has to do with the legal restrictions on the investments insurance companies are allowed to hold.

Hospitals and insurers are certainly in collusion to wipe out private practice. Typically how that works is that the practice will have a contract with the hospital where they work as well as contracts with various insurers to establish billing rates. The insurance company will approach the practice and tell them that they are going to cut reimbursement 25% this year and 10% the followi

You need to call the GOP... I hear they're having real trouble finding ACA horror stories that don't turn out to be utter bullshit after thirty seconds of digging. Your story isn't utter bullshit like all the others, is it?

This is what you're referring to.

http://www.nytimes.com/2014/02... [nytimes.com] Health Care Horror HooeyPaul KrugmanFEB. 23, 2014(Right-wingers convinced Americans that farms are being broken up to pay "death tax" estate liabilities, but there is not one single example. Now the Republicans are creating Obamacare horror stories, which don't hold up upon fact checking. In the GOP response to the State of the Union address, Rep. Cathy McMorris Rodgers claimed "Bette in Spokane" had lost her good insurance and was forced to

LOWER TAXES, LESS REGULATION and a government doing its job by enforcing the laws equally between the little guy and the mega corp... rather than giving preferential treatment to whomever pays the most.

So we're shifting the tax burden off of the businesses - are you then in favor of higher property taxes? A larger income tax? Maybe you'd like to cut programs to help poor people? Is there any evidence that shows lower taxes make the economy stronger or the country better?

Now which regulations are we going to get rid of? Typically the government adds regulations in response to abuse of the system. Maybe we should let companies pollute the rivers as long as they promise not to do it too much? How about lower the safety requirements as long as not many people get chewed up by machinery. Or maybe just let people discriminate against the handicapped.

But yeah, let's worry about getting people health care because it was working perfectly before Obama came along and ruined it for everyone.

Removing the tax structures that make companies by default intermediaries in the provision of health insurance, and allowing more interstate (and international) competition in health finance options would help on that front, too

Translation: if we can remove one of the incentives for companies to provide health care plans, then more people will be forced to buy private health insurance! Yay!

Congratuations, you've just found out what the Republicans felt was the best system for healthcare. If the Democrats had had there way, it would be single payer - not "how much profit can we make" insurance companies.

allowing more interstate (and international) competition in health finance options would help on that front, too

Yeah, how'd that work out for banking? Interstate competition was supposed to do things like drive down credit card interest rates.

Instead, almost every credit card in the US is issued out of Delaware or South Dakota. And interest rates are quite high. Why? Interstate competition also means competition between state legislatures for laws that are most favorable to banks.

So what would happen with interstate health insurance? Legislatures would compete for the most insurance company-friendly laws. Which would be the least consumer-friendly laws.

You need to ask yourself your own question. Competition works out really well for so many things that you take for granted here. And instead you cherry pick one small aspect of one industry that you feel supports your opinion.

Interest rates on credit cards are high for a reason - they're a high risk loan. People that carry credit card debt are at high risk for declaring bankruptcy. The system is working correctly. Meanwhile, I love my bank. Free checking, great service. Interstate competition in banking has been fantastic. I've got 6 separate banking options within walking distance of my house. 2 national, 2 local, 2 credit unions. Heck, there are only 4 liquor stores in walking distance.

Because the crisis, by exposing the clubby and monopolistic nature of the current healthcare process, will cause its economic model to collapse. The feds will undoubtedly try to impose price controls, because this is the only way they know how to respond in such a situation. At that point, healthcare will FINALLY have to accept the more open-market approach that so many of us have suggested: prices "on the wall" for all procedures so the consumer can make open choices, freedom to shop around worldwide for b

Right now, the market is so muddled I can't even tell from my non-functioning state website whether I qualify for subsidies or not, let alone be willing to put 1/6th of my paycheck towards health insurance that has such a huge deductible it will only pay if I get in a major accident.

People, particularly young people, who want to start their own businesses, usually have to scrimp and save to come up with the initial capital. One method of doing this was to forgo health insurance for a few years, or to buy catastrophic medical coverage.

No more. Cheap, high deductible policies are no longer allowed. And if you forgo coverage, the gov't will take it out of you in the form of a penalty.You can sign up for low income assistance, but forget trying to amass any startup capital or you'll run afoul of the means test.

I feel sorry for young people who are trying to get ahead. I've been self insured for years and now, thanks to the ACA, my medical insurance costs will be passing my housing costs. And I don't live in a cheap area. I can practically spit on Bill Gates house from here.

Back when I worked for one of the top defense contractors, they really didn't pay us very competitively. I was looking around, and encouraged a good friend of mine to do so as well. He was a really good engineer, and deserved better. Unfortunately, he told me he couldn't.

You see, a few months after hiring on right out of college, he discovered he had diabetes. Our employer's insurance continued covering him (because they had to), but if he tried to go anywhere else nothing diabetes-related would be covered

How about instead of cost shifting and purchase pooling we actually work on what medical care costs in the first place? In the US you can got to Cook County or the US Federal court in the Eastern District of Texas and drive up a drug company's everyday costs by suing them in a class action for side effects they already disclosed before you bought their drug. There should be some sort of grand jury or board of people with a clue who decide the merit of these things before millions are spent on lawyers.

The for-profit speculative commission-only trial lawyers are a big part of service and product costs for drug companies, hospitals, clinics, doctors, nurses, and even medical assistants and medical techs. If you want to make healthcare more affordable through insurance cost changes, change the cost of malpractice insurance so that only people who actually screw up need to pay exorbitant premiums. When I lived in Illinois it was really difficult to get a doctor's appointment within six months without crossing state lines because the malpractice rates caused several of the doctors in the area to retire early or move to more sensible states.

Also, why do we have federal and state funds going into basic research at universities that gets patented and sold to corporations to turn into products? If research comes from a largely government-funded school then the NIH or someone should be licensed to then sublicense any of those patents to all comers for a reasonable fee.

Also, why do the drug companies pay the FDA to fast-track drugs? The PDUFA [fda.gov] means that in order to get faster drug trials, the deeper pockets get faster times to market. If we're spending billions of dollars to improve healthcare, why don't we fund the FDA sufficiently to get the best drugs approved fastest rather than the most heavily promoted ones? Why don't we partner with other developed countries to do joint trials that meet the standards of the FDA and its counterparts in, say, the UK, Germany, France, Japan, South Korea, Canada, Finland, Sweden, and Brazil with all the agencies reviewing all the data and making decisions for their own constituencies rather than repeating the trials over and over?

Then push for an intelligent universal health care system, like the Commie Canucks have (instead of a hammer and sickle they put a moose and maple leaf on their flag). Getting employers out of health insurance is good for both large and small businesses, as well as people. About the only ones worse off are the insurance and drug companies.

BTW, despite the glorification of small business in the US, Europe actually has a larger percentage of its economy in small business. I'd be very surprised if that wasn't

When that happens in the US you try to fill the prescription anyway and the pharmacy calls the doctor's office to get a "pre-authorization" - usually within two days. They don't do that in pharmacies in Canada?

About 46k people came down from Canada to the U.S. to get health care in 2011. Quite a bit of that was paid for by the Canadian health care system, not out of pocket. That's pretty much in the noise. Statistics on how many people come down from the U.S. to get health care in Mexico because they can't afford to get it in the U.S. are harder to come by because people who do that generally pay out of pocket, but the number is comparable, and the reason is different: U.S. citizens going to Mexico are doin

Quality. They come to go to places like the Mayo Clinic. The health care problem in the US is not the quality of the health care, its the quantity of health care. Sure maybe you can make a case that adding more health care might lower the average quality, but I highly doubt that places like Mayo are really going to be affected that much.

I'm in exactly the same situation. We had a group plan with Blue Cross / Blue Shield of Texas. We spent a good amount of time shopping for a plan that fit our needs well, with the right coverage and the right deductible for us. In the last two years the cost has nearly doubled. I left the business I'd had for 17 years and am now working for a government agency related to security.

he U.S. has an infant mortality rate that dwarfs comparable nations, as well as the highest teenage-pregnancy rate in the developed world, largely because of the politically-motivated unavailability of contraception in many areas."

Seriously? I don't know of anywhere in the US where contraception is not available. They sell rubbers at all drug stores and most every grocery store I've ever been to. I'm born and raised in the south o

Availability is a loaded word in this case. Go buy condoms as a 14 years old in an area where religious people want to burn people who use contraceptive on a stake....good luck (of course IMO they shouldn't need it at that age but the reality is different). You may also be in an area where your doctor will try to convince you not to get contraception. They'll prescribe it if you INSIST....

Compare that to an area where schools have someone on staff who can prescribe pills, or doctors will insist you consider

Compare that to an area where schools have someone on staff who can prescribe pills, or doctors will insist you consider it...

Where in the word do you live at, where anyone at a school can fucking prescribe medication?!?!??!

Availability is a loaded word in this case. Go buy condoms as a 14 years old in an area where religious people want to burn people who use contraceptive on a stake....good luck (of course IMO they shouldn't need it at that age but the reality is different). You may also be in an area w

Availability is a loaded word in this case. Go buy condoms as a 14 years old in an area where religious people want to burn people who use contraceptive on a stake....good luck (of course IMO they shouldn't need it at that age but the reality is different). You may also be in an area where your doctor will try to convince you not to get contraception. They'll prescribe it if you INSIST....

Compare that to an area where schools have someone on staff who can prescribe pills, or doctors will insist you consider it...

You end up with 2 totally different world. They're available in both cases, its just a different definition of available.

FWIW, those both sound like horrible, horrible places, and I'm glad I don't live there.

Around these parts, which I like to refer to as the Buckle of the Bible Belt, they lock the "generic" contraceptives (condoms, spermicide, etc.) up in a glass cabinet (because of theft), and I'm pretty sure you have to be at least 16 to buy them. For the "strong stuff," i.e. birth control or Plan B, you've got to go talk to either your doctor, or the nice folks down at Planned Parenthood.

Around these parts, which I like to refer to as the Buckle of the Bible Belt, they lock the "generic" contraceptives (condoms, spermicide, etc.) up in a glass cabinet (because of theft), and I'm pretty sure you have to be at least 16 to buy them. For the "strong stuff," i.e. birth control or Plan B, you've got to go talk to either your doctor, or the nice folks down at Planned Parenthood.

Your part of the bible belt sounds much different than my notch in the bible belt I've lived in and grew up in.

Sure, they argue and do not teach sex ed in some schools because of the religious idiots but every kid out there can get condoms. As simple as walking into any 7-11 and paying for them. For the record, I had no issue doing it 30 years ago and my kids had no issue doing it in the last couple of years.

And as for the Rep. govenors that refused the Medicaid expansion, they did the cost analysis.

I call bullshit on it having anything to do with a cost analysis. This was ALL about politics. This is simply republicans dragging their heels at the expense of a bunch of poor people for political grandstanding. I live in a state with a Republican governor and a republican majority legislature and they passed the medicaid expansion because it makes financial sense. The terms of the deal are quite clear and the cost of providing medical care to those poor people isn't going to go away whether or not the

It is the same problem as in poor parts of Africa too. People don't WANT to be helped.

If you look in the areas that are against that kind of healthcare, its often poor people in the south, and the ones that are for it are frequently upper middle class in rich cities.

I'm in Boston. Pretty much everyone is for universal healthcare. No one (in my circles) would benefit from it. We all have pretty much perfect company funded healthcare with little to no deductibles, often with premiums paid by our employer, which let us go to one of the best hospital in the world (MGH) for pretty much no money. If they were to get the money from it from taxes, the same people would be disproportionately affected by them (already in upper tax brackets, at the bottom end of the groups affected by AMT....it hurts)

Yet these same people who would get NO BENEFIT from it, and would lose a lot of money in the process, are in favor of it. And those who'd get the free lunch are against.

Now, don't get me wrong. In its current implementation they have a point sometimes: poor people who aren't poor enough to get subsidies and now have to pay premiums are getting hit hard by them, especially if they see themselves invincible and haven't seen an hospital bill in their life. But that wouldn't be an issue if it was fully funded healthcare, not just the bastardized in between that we currently have.

mainly Republicans, have refused to expand Medicaid, which provides health insurance for low-income Americans. Although the federal government will pay for the expansion, many governors cited cost, even though the expansion would actually save money.

You must have skipped the fine print on this one.

The Feds will pay for the Medicaid expansion for the FIRST THREE YEARS. After that, the State is on the hook to cover it.

Which is why cost is an issue, since the States are generally in the same shape as the Fe

The Feds will pay for the Medicaid expansion for the FIRST THREE YEARS. After that, the State is on the hook to cover it.

Technically true. The federal government will pay 100% of the cost for the first three years, then 95% of the cost, dropping to a minimum of 90% of the cost in 2020. So the state is on the hook to pay... 10%!

Sure, it's crazy that a state should have some responsibility for it's citizens, even a 10% responsibility. As you say, we should give all responsibility and money and power to the federal government.

In Oregon, there's actually a program to make "Double-Dipping" legal. Basically, if you can find a way through self employment to earn up to 25% of your unemployment check, you can. If you earn more than 25%, your check is reduced dollar for dollar to 125%, at which point it disappears (and presumably, at which point you're the equivalent of fully employed at about $1 over minimum wage anyway, and no longer need the check).

In the U.S., if you're working independently, or even trying to, you're not eligible for unemployment.

I ran into this myself and was shocked.

I paid quite a lot into the unemployment system while working through my own company, but when I lost contracts and was in between job, I could not collect unemployment, even though I'd paid into the system.

Honestly, if I ever win the powerball, I'd take the money to hire legal guns and fight shit like this just on principal.

Why would anyone think the Government could run healthcare? Is there any sign of competence or efficiency in Medicare, Medicade, or the VA? All are inefficient and fraud ridden with time wasted by reams of worthless paperwork. There is not one single thing that the Government of the US has ever done more efficiently than the private sector.

Anyone who was in the US military or was a dependent of the US military can tell you they did a pretty good job with Tricare. Healthcare was an invisible cost to me when I was a kid. If I was sick, I went to the doctor, no questions asked (and got a visit to my father who worked civil service in the Army hospital after he retired.)

They've been messing with the model due to budget cuts over the last few years, and I hear it's not as rosy as it used to be. But for the first 18 years of my life, I never

You're talking out of your ass. I was an army brat as well my entire childhood. You know what the two cheapest and highest rated (by those covered) healthcare programs were circa 2008? Evil, socialist VA hospitals and Medicare.

Let's see, maybe because they already do through Medicare and other programs. Maybe because governments around the world do a highly competent job of it for better outcomes and lower cost than we incur in the US. Maybe because reflexively assuming governments are incapable of doing anything well is demonstrably false. Maybe because health insurance is a marketplace that is used by everyone and CANNOT be operated effectively or humanely without government involvement.

Is there any sign of competence or efficiency in Medicare, Medicade, or the VA?

Quite a bit actually. Not saying they don't have their flaws (they do) but they are hardly the debacles you seem to be implying.

There is not one single thing that the Government of the US has ever done more efficiently than the private sector.

What a bunch of crap. There are plenty of things the private sector does an absolutely crap job of. Policing, firefighting, military, infrastructure, medical care for at risk groups (elderly and poor especially), basic research, the judiciary, banking regulation, environmental protection, and quite a bit more. Any time you have a situation where market forces do not work well, the private sector is demonstrably unable to deal with the problem. I'm all for doing as much with the private sector as we can but the argument that the private sector is always better is absurd, wrong and frankly damaging to our society.